Abstract
BackgroundIn Central Vietnam, forest malaria remains difficult to control due to the complex interactions between human, vector and environmental factors.MethodsPrior to a community-based intervention to assess the efficacy of long-lasting insecticidal hammocks, a complete census (18,646 individuals) and a baseline cross-sectional survey for determining malaria prevalence and related risk factors were carried out. Multivariate analysis using survey logistic regression was combined to a classification tree model (CART) to better define the relative importance and inter-relations between the different risk factors.ResultsThe study population was mostly from the Ra-glai ethnic group (88%), with both low education and socio-economic status and engaged mainly in forest activities (58%). The multivariate analysis confirmed forest activity, bed net use, ethnicity, age and education as risk factors for malaria infections, but could not handle multiple interactions. The CART analysis showed that the most important risk factor for malaria was the wealth category, the wealthiest group being much less infected (8.9%) than the lower and medium wealth category (16.6%). In the former, forest activity and bed net use were the most determinant risk factors for malaria, while in the lower and medium wealth category, insecticide treated nets were most important, although the latter were less protective among Ra-glai people.ConclusionThe combination of CART and multivariate analysis constitute a novel analytical approach, providing an accurate and dynamic picture of the main risk factors for malaria infection. Results show that the control of forest malaria remains an extremely complex task that has to address poverty-related risk factors such as education, ethnicity and housing conditions.
Highlights
In Central Vietnam, forest malaria remains difficult to control due to the complex interactions between human, vector and environmental factors
As hammocks are commonly used in this area, in the forest, the introduction of Long-Lasting Insecticidal Hammocks (LLIH) might be an effective intervention to protect against malaria infections
This paper presents the socio-demographic and malariometric data at baseline together with a malaria risk factor analysis combining two different, but complementary approaches: multivariate analysis and classification and regression tree (CART)
Summary
In Central Vietnam, forest malaria remains difficult to control due to the complex interactions between human, vector and environmental factors. The recent introduction of Long-Lasting Insecticide Nets (LLINs), not officially adopted by Vietnam yet, has overcome the problems of low re-treatment rates, washing and variation in insecticide dosing, possibly improving their effectiveness [3,4] Against this extremely positive background, malaria remains a problem in some geographically limited areas, usually rural and remote, forested and hilly, representing a risk for the local population and for migrant workers from nonendemic areas. In recent studies carried out in the forested areas of Central Vietnam, forest activity has been identified has a strong risk factor for malaria infection [10,11] This calls for a new approach targeting forest workers and addressing the behavioural characteristics of the local vector. As hammocks are commonly used in this area, in the forest, the introduction of Long-Lasting Insecticidal Hammocks (LLIH) (locally made hammocks covered with long-lasting insecticidal netting) might be an effective intervention to protect against malaria infections
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